Where Is the Oversight?

Just before Christmas I read an article about a case in Texas where a doctor was sentenced to a lengthy prison term for a scheme to defraud Medicare and Medicaid in excess of $25 million. The doctor had been approached by individuals offering to pay him a kickback for supplying Certificates of Medical Necessity (CMN) approving a beneficiary to receive a motorized wheelchair. I have been watching TV and seeing these adds for sometime about scooters for disabled individuals and I was wondering how so many people could be approved by Medicare and Medicaid to receive these products. At least in this one case in Texas, the doctor was being paid money by the suppliers of these motorized wheelchairs to certify that the people needed them.

In the case in Texas, according to the government, the doctor involved not only got a kickback for signing the CMN but told the disabled patient that unless that patient utilized his services for even more fraudulent billing of Medicare and Medicaid claims that he would not sign their CMN and help them get their wheelchairs. According to prosecutors, the supply companies who provided the wheelchairs in many cases provided less expensive scooters to the patients or nothing at all. The cost to the government, over $25 million in claims.

This case is a classic example of where the government’s pocketbook is opened for looting by those who have no compunction to do so. Given the large amounts of money going to this doctor one would think that the government’s computerized system would have picked up that something was amiss. Before the scheme was uncovered, $25 million in taxpayer money was paid out to those involved in the conspiracy to defraud the government. Because of the lack of oversight, these people operated for several years with impunity. While the articles I read did not say how it is that the scheme was finally brought to the attention of the government (I would suspect an informant), at least these people were caught and prosecuted. One would hope that the informant had filed a qui tam action under seal and that he and his attorneys were paid for bring this outrageous fraud to the attention of the government.